The varied sonographic appearances of focal fatty liver disease: review and diagnostic algorithm.

Focal fat infiltration and focal fat sparing of the liver are less common than diffuse fat infiltration but present a greater diagnostic conundrum. Although typical features of these conditions are well described, there is a wide variety of different appearances. These atypical patterns present significant difficulty in differentiation from other pathological processes and often require additional investigation. We present an innovative diagnostic algorithm and illustrate its effectiveness in diagnosing focal fatty liver disease with typical and atypical examples.

Assessment of real-time PCR for quantification of Legionella spp. in spa water.

AIMS: Legionella bacteria ubiquitously colonize natural freshwater and are responsible for legionellosis in humans. Several cases of legionellosis have been associated in particular with the use of whirlpool spas. The objective of this study was to verify whether real-time PCR is applicable for the quantification of Legionella spp. in spa water. METHODS AND RESULTS: The study compared concentrations obtained by real-time PCR vs that obtained by conventional culture for 101 spa water samples. For the culture method, Legionella spp. were detected and quantified in 14 of 101 samples with measured concentrations ranging from 250 to 3.5 × 10(5) CFU l(-1). With the real-time PCR method, Legionella spp. were detected and quantified in 42 of 101 samples with concentrations ranging from 1000 to 6.1 × 10(7) GU l(-1). Results revealed a significant but weak correlation (r(2) = 0.1867) between the two methods. The positive predictive value (35%) of the PCR method compared to conventional culture herein was low. In contrast, the negative predictive value was excellent, reaching 93%. CONCLUSIONS: Real-time PCR could be used as a screening tool to rapidly ascertain the absence of Legionella spp. in spa water. However, a positive result involves the need to resort to conventional culture. SIGNIFICANCE AND IMPACT OF THE STUDY: Data of this study highlighted the pros and cons of quantification of Legionella spp. in spa water with real-time PCR using a commercial quantitative PCR kit in a routine laboratory, when compared to conventional culture.

[Propofol versus methohexital in the surgery of the spinal canal]. / Propofol versus méthohexital dans la chirurgie du canal rachidien.

The aim of this study was to compare the quality of postanaesthetic recovery after anaesthesia with methohexitone (M) or with propofol (P). Thirty patients undergoing spinal surgery were randomly assigned to either group. The induction dose was 2 mg . kg-1 for both M and P. Anaesthesia was maintained by continuous infusion. The rate was 0.15 mg . kg-1 . min-1 for P and 0.07 mg . kg-1 . min-1 for M. Analgesia was obtained with fentanyl with the same doses in both groups. The maintenance doses were subsequently decreased by 50 and 75% of the initial values. This work compared the quality induction and the criteria of recovery (Aldrete score, Newman test). In two patients in each group, sensory evoked potentials (SEP) were recorded to monitor neurological integrity. The quality of induction was similar in both groups. Awakening was significantly more rapid in group P. The SEP were much decreased in group P, whilst there were few changes in group M. Monitoring of medullar integrity is mandatory in spinal surgery, requiring a rapid recovery. This objective was obtained with shorter delays in patients anaesthetized with propofol than in those who had received methohexitone. However, the former, at the doses used, seemed to depress the SEP.